Can I Take Vitamins and Supplements To Boost My Immune System?

The COVID-19 pandemic has caused healthy people to think about ways to stay as healthy as possible. There are many ideas about how to stay healthy including drinking more water, getting more sleep and exercise. One place people are turning to for help is through vitamins and supplements.

However, should everyone begin a vitamin regimen? And, where should we start with taking vitamins?

In this Q&A, Hannah Kittrell, MS, RD, CDN, Clinical Research Associate and Director of the Mount Sinai Physiolab, provides some advice on which vitamins people should begin taking and discusses if supplements can really boost your immune system.

We hear a lot about taking vitamins, herbs, elderberry syrup, and other supplements to boost your immune system during the pandemic. Is it possible to ‘boost’ your immune system?

It depends on how you define “boost”, but there are certain nutrients that are vital for optimizing immune function. The immune system is a complex, interconnected system that requires all of its parts to work in harmony to function at its best. It is easy to “boost” a single entity, but something as complex as the immune system, not so easy.

There are specific nutrients that contribute to a healthy immune system, such as zinc, selenium, iron, copper, folic acid, vitamins A, B6, B12, C, and E, and the essential fatty acid omega-6 (linoleic acid). Deficiencies of these micronutrients may impact the immune system in a negative way.

To note, adequate amounts of these micronutrients can be easily obtained through eating a well-balanced diet composed of whole foods, with lots of fresh fruits and vegetables. Supplementation may be indicated in the case of deficiency, but you should always check with your doctor or a clinical dietitian prior to starting a supplementation regimen.

Where should you start in your vitamin regimen? A multivitamin? Vitamin C?

A general multivitamin is fine to start, however, adequate amounts of vitamins and minerals can be obtained through eating a well-balance diet. However, people who are likely deficient may also warrant supplementation. We recommend taking a look at your last blood test, which would show any recent deficiencies. Additionally, a comprehensive dietary evaluation conducted by a dietitian would determine dietary habits that can be improved upon.

What vitamins and minerals should we be certain to take in adequate amounts?

It is difficult to generalize vitamin/mineral needs for a large group of people, as supplementation recommendations are based on deficiencies or likely deficiencies for reasons such as access to food, malabsorption, or medical conditions, and can vary greatly from one person to the next.

However, there are certain micronutrients that are of importance for certain groups:

Children—Iron, vitamin D, vitamin A, vitamin C, calcium

Women—Iodine, vitamin D, vitamin B12, calcium, iron, folate

Adults— Iron, iodine, vitamin B12/B6, vitamin D, vitamin C, calcium, vitamin A, magnesium

Seniors—Vitamin B12, calcium, vitamin D, iron

Based on a nutrition report from the Centers for Disease Control and Prevention, the top five most common nutrient deficiencies among people who live in the United States include vitamin B6, iron, vitamin D, vitamin C, and vitamin B12. These deficiencies are mainly due to poor nutrition. And, again, if you follow a healthy food plan and eat adequate amounts of fruits and vegetables, in a variety of colors, then you should not have to worry about any micronutrient deficiencies.

How can we best support our immune system during quarantine?

The best way to support your immune function is by living a healthy lifestyle.

Be sure to get enough sleep. That is seven hours for adults, nine hours for teenagers, and 10 hours for children 12 and under.

Drink plenty of water—two cups shortly after waking and six to eight more throughout day—and stay active.

Also, everyone should try to eat a well-balanced diet with lots of fresh fruits and vegetables, as well as high quality sources of protein and fat like nuts, seed, legumes and beans, eggs and fish.

I Have A Cavity. Is It Safe to See My Dentist?

Although many are under stay at home measures due to the novel coronavirus pandemic, there are still some everyday issues that cannot be avoided—like dental pain. But, can you see a dentist during this time?  John L. Pfail, DDS, Chief of the Department of Dentistry at the Icahn School of Medicine at Mount Sinai, explains which procedures can be addressed and which will have to wait.

Are dental procedures still being done in the office?

Currently, the American Dental Association (ADA) and the New York State Dental Society will only allow emergency procedures. COVID-19 is spread through respiratory droplets from the nose and throat. Some dental procedures can create large amounts of these droplets in the air, for example through cleanings and fillings, which could spread the virus.

Out of an abundance of caution, elective surgery, routine restorations like fillings and all procedures involving the use of an ultrasonic scaler—which is used to clean teeth as well as remove stains and plaque—have been postponed. If patients are experiencing mild discomfort, they should contact their dentist who can evaluate and advise if they should wait until a possible reopening of offices in late May.

What types of procedures are considered an emergency?

Emergency procedures depend upon the level of pain or discomfort the patient is experiencing. However, these procedures would include the following:

Emergency treatment for pain and swelling

Depending on severity these would include medicated restorations—fillings, drainage of swellings and infections, as well as the removal of the inflamed nerve tissue of a tooth—pulpotomy

Extraction of severely mobile, fractured, or decayed teeth

Denture adjustments of sore spots

These spots should be attended to as they can lead to open wounds that may become further complicated, causing infection.

Refilling prescription medications

Please consult with your dentist. With the advent of telemedicine, you may not need to come in to the office to be seen.

I have an emergency dental procedure. Is the office safe?

Yes, it is very safe as dental offices follow strict protocols on infection control and asepsis–being free of any disease causing organisms, this includes viruses and bacteria.

Additionally, the ADA is currently completing new guidance for when dental offices reopen for all procedures. Social distancing will be maintained, patients will be screened with temperature checks, and visitors will be limited. These are just a few of the changes that will be noticed in the dental office.

Will Using A Steroid-Based Nasal Spray Increase My COVID-19 Risk?

The Centers for Disease Control and Prevention considers those who are actively being treated with high-dose corticosteroids to be immunocompromised. Most nasal sprays for allergies do not fall into this category. Consult your primary care physician regarding the specific medication you are taking.

Allergy sufferers are hyperaware of every cough, sneeze, and sniffle entering the height of this allergy season. Those with allergies are not only concerned with distinguishing their allergy symptoms from the novel coronavirus that causes COVID-19, but many are now worried that the medications they take to manage their symptoms might put them at increased risk.

Steroid-based nasal sprays have come under particular scrutiny because the active ingredient—corticosteroids—can reduce the strength of the body’s immune system, which is concerning during a pandemic. Fortunately, nasal spray users need not worry. Anthony Del Signore, MD, PharmD, Director of Rhinology and Endoscopic Skull Base Surgery at Mount Sinai Downtown-Union Square, explains why allergy sufferers should keep using their medications.

Should I stop using my steroid-based nasal spray?

If patients are getting the relief that they usually receive from taking these medications, I typically say to continue using them. Often, symptoms of nasal drainage, nasal obstruction, or sinus infections will increase if you come off of the medications.

It is also important to remember that with topical intranasal sprays, as well as topical nasal rinses with steroids in them, the absorption of the steroid is quite low. And, there is conflicting evidence as to whether or not steroids taken this way will actually cause any decreased defense against the virus.

A lot of the data and recommendations that we’re getting is for systemic steroids, which are steroids taken by mouth or administered intravenously. That’s where we are seeing the decrease in the immune system.

As a result, I am staying away from prescribing oral steroids for the time being. But topical nasal sprays, as well as topical rinses, I’m okay with.

I take an allergy pill. Are there steroids in my medication?

We do not typically give oral steroids to patients complaining about the typical symptoms of seasonal allergies. Instead, we recommend nasal rinses/netipot, oral antihistamines, and intranasal antihistamines as well as intranasal steroids, with pretty good effect and results.

Oral steroids are usually reserved for more serious conditions like asthma, lupus, or severe systemic allergic reactions. And, if you have a more serious condition that requires the use of these oral steroids, you have to weigh the risks and the benefits. I would counsel these patients to practice social distancing, good hygiene, and taking other precautions. These preventative measures can often tip the scale so that the benefits outweigh the risk of the steroids.

What should patients do if they are concerned that their medications will decrease their ability to fight off COVID-19?

There’s a lot of information out there, and patients may be having a tough time finding the right answers. If patients have any questions during these tumultuous times, they should consider setting up an in-person or telemedicine appointment to talk with their health care provider. After getting a global view of the patient and seeing what other risk factors they have, proper recommendations can be made that may at least help to put fears at ease at a time that’s very uncertain for many.

What are COVID Toes and Should I Worry about Them?

Doctors are reporting that they are beginning to see cases of “COVID toes,” red or purple patches on toes that some believe could be a sign of the novel coronavirus (COVID-19).

While the scientific evidence is still limited about what may be causing this medical condition, people who have this symptom should contact a dermatologist or their health care provider, according to Noelani Gonzalez, MD, a dermatologist and Director of Cosmetic Dermatology at Mount Sinai West in New York.

“Your doctor will follow up by asking you questions to try to figure out if this could be a possible sign of coronavirus or something else,” she said.

In fact, the patches on the toes resemble another condition called chilblains, also known as pernio, a painful inflammation of small blood vessels. People may often feel itching, stinging, or burning.

In most circumstances the condition resolves on its own and doctors recommend behavioral measures such as keeping your feet warm, but in persistent cases topical steroids can help reduce inflammation, and aspirin can help improve blood flow to your extremities. Fortunately, the condition tends to go away within a few days or up to two weeks, according to Dr. Gonzalez.

This is a condition doctors typically see in the colder months, which is one reason why the recent reports, while the weather is warming, may be an indication of something different, she said.

In order to gather better information, the American Academy of Dermatology recently started a COVID-19 Registry to collect reports of this condition from physicians and health care professionals so that they can be studied, and to avoid the spread of medical misinformation.

Dr. Gonzalez says “COVID toes” has been found among people of all ages, though many of the cases have been among children and young adults. Doctors believe that may be because younger people typically mount more aggressive immune responses to a virus or other infection.

Doctors say this type of inflammation in “COVID toes” can be caused by the inflammation caused from the immune response to the virus, by an inflammation in blood vessels, or by clotting in blood vessels, or even by a combination of these, but there is not yet a definitive answer.

My Child’s MMR2 Vaccine Has Been Delayed Due to COVID-19. Should I Be Concerned?

The novel coronavirus (COVID-19) pandemic has postposed many important events, including your child’s immunizations. The MMR2—the second shot of the measles, mumps, and rubella vaccine—is particularly important for New York area parents who remember the past year’s measles outbreak. Stephen Turner, MD, Medical Director, Mount Sinai Doctors Brooklyn Heights, explains why parents need not worry if their child’s vaccination has been postponed.

Should I be concerned about delaying my child’s second MMR?

Fortunately, we do not have any measles circulating in the population at this time. So, it is a very reasonable option to delay the second MMR until a parent feels comfortable going to the physician’s office and getting the vaccine. The second dose, although most frequently given at age four, is recommended to be given between ages four to six according to the Centers for Disease Control and Prevention immunization schedule, which gives a lot of flexibility for your child to be fully vaccinated on time. 

Will delaying the second MMR put my child at any increased risk?

The second MMR is not a booster dose; it is to increase the immunity rate among the population. After one dose of MMR, approximately 92 percent of people are immune to measles. The second dose increases the immunity rate to 97 percent or higher. Therefore, a child who has received one MMR is very likely already immune.

How long can the vaccine be delayed?

There is no limit to how long the MMR2 vaccine can be delayed. In general, vaccines have a minimum spacing but not a maximum spacing. So, if a second dose of a vaccine is supposed to be two months later, for example, and you came back in two years, you pick up where you left off and get the second dose. Your child will not have to restart the vaccine series.

What’s the Right Diet for Me?

Every day, there seems to be a new diet trend: keto, paleo, Atkins, the Mediterranean diet, or the South Beach diet. To someone trying to lose weight or eat healthier, the choices can be overwhelming. We sat down with Jennifer Cholewka, RD, CNSC, CDCES, CDN, Metabolic Support Dietitian at The Mount Sinai Hospital, to separate myths from facts and to get some guidance as to where to start.

As I look at the wide variety of diets out there, where do I begin?

To your point, diet trends are always evolving and changing. One minute, everyone’s talking about a superfood that’s good for you, and next year, all of a sudden, that food is bad for you and “out.” We’ve seen that with eggs, coffee, fats, carbs, and all kinds of things. But the first thing to ask yourself is, “What’s my goal?” If your goal is weight loss, the answer might be different than if you’re trying to live heart-healthy.

The word “diet” isn’t a great word in the world of dietitians. People see the word “diet” and often think of a quick fix. But we should really be thinking in terms of “lifestyle” instead. Whatever diet you choose, it should be sustainable, obtainable, and reasonable within your current life.

A lot of people are attracted to some of the extreme diets, like keto, Atkins, or paleo, because they want to lose weight quickly. And you will see weight loss quickly, but it’s not something that you can maintain for your life. These diets usually restrict entire food groups, which forces your body to change the way your metabolic processes work. For example, the keto and Atkins diets restrict carbohydrates, including sugars, grains, and certain vegetables and fruits, while the paleo eliminates foods like grains and most dairy products.

Is that unhealthy?

Yes, I think it’s unhealthy. People have a tendency to “yo-yo” with these diets, or in other words, lose the weight and then regain it. Because you’re restricting entire food groups, your body can’t stay on it forever. That’s why the first thing you should think about is, “What is sustainable?”

What do you mean by “sustainable?”

Your lifestyle plays an important role in what type of diet you should follow. For example, intermittent fasting is a very popular diet lately. There are many different types of intermittent fasting, but one example would be to only eat between noon and 8 pm. For many people, that’s not possible because of their work schedule or their home life. The extreme diets we mentioned are not sustainable because they eliminate entire food groups. They force our bodies into unnatural metabolic processes, and you can’t keep it up. That’s why we need to shift our mindset from “diet” to “lifestyle.”

It’s better when a person makes small changes that are manageable and attainable. You probably shouldn’t change every aspect of your diet at once. Maybe you’ve identified that you need to stop drinking soda, decrease fast food consumption, and exercise more. Doing all three of those at once may be overwhelming and frustrating. Implement changes that are doable, and tackle those goals, one by one. And acknowledging your accomplishments is key.

What it comes down to is, a person should:
1. Identify their goals.
2. Figure out what’s sustainable.
3. Make sure your diet has balance.
4. Recognize that portion control is key. 

So say my goal is losing weight. What’s the best diet for weight loss?

I’m not a huge fan of any one diet in particular, but if your goal is weight loss, my No. 1 recommendation continues to be Weight Watchers, which allows you to eat all kinds of foods but carefully track what you eat. It has a lot of those things that I view as very important—including balance and portion control. I feel the Weight Watchers approach is very manageable for a lot of different lifestyles. It’s doable whether you work 9-5, work nights, or travel. I find it to be a very reasonable and sustainable approach. You’re able to treat yourself if you want, but you’re encouraged to eat foods that are much healthier, such as lots of fruits and vegetables, and lean proteins. The support aspect of Weight Watchers is also very helpful for people, whether it’s going to an in-person meeting or getting connected to a coach who can help you.

The Mediterranean diet, which focuses on vegetables, fruits, whole grains, seafood, and olive oil, has a lot of pros, as well. It encourages balance; it encourages eating more whole foods; it’s low in processed foods. It also allows alcohol, which is important to some people.

The DASH diet, or Dietary Approaches to Stop Hypertension, is a diet developed through research sponsored by the National Institutes of Health. The DASH diet is similar to the Mediterranean diet and is a low-sodium diet that’s heart healthy. These three diets are almost always the top diets recommended by U.S. News & World Report. Their recommendations are updated every year and they list their top diets for different goals. That’s a good place for people to start.

And if your goal is weight loss, “calories in, calories out” is really going to drive weight loss. So portion control is critical, as is exercise. Again, make small changes that are sustainable. You won’t be able to hit the gym five days a week to start. You might try committing to walk one day a week on the treadmill for 30 minutes. Or walking instead of taking the subway. It sounds small, but you’ll see changes that last over time.

People are always going to look for ways to lose weight as fast as they can and keep it off. But there’s never going to be a quick fix for anything.

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